Exercise Interventions With Trained Home Helpers for Preventing Loss of Autonomy and Falls in Community-Dwelling Older Adults Receiving Home Heath Physical Therapy T4H: A Randomized Controlled Pilot Study.

BACKGROUND AND PURPOSE: Older adults at risk for falls live independently in the community in their own home and have rehabilitation needs. However, little is known about whether home coaching of older adults can decrease falls at home. We sought to determine whether a novel program for preventing falls and a loss of exercise capacity, the T4H program, in which home helpers act as exercise coaches by using an information technology (IT) device, was acceptable and feasible. METHODS: Between February 2015 and October 2015, we performed a cluster randomized controlled trial in which home helpers either assisted older adults 75 years and over, to participate in the T4H program, or provided standard home help over 3 months. We assessed levels of acceptability and satisfaction among the older adults and home helpers with regard to the exercise program and the technologies used. To measure efficacy, the main outcome measures for the older adults were the absence of falls requiring medical or paramedical care, unplanned hospitalizations, walking ability in a Timed Up and Go test (TUG), and self-care ability by the Barthel Index at the 3-month follow-up visit. RESULTS AND DISCUSSION: Overall, 35 older adults were included, aged 89 years and with 68.6% women. Eighty-five percent of the respondents were pleased or very pleased to have participated in the T4H exercise program, 70% were satisfied with the IT devices, and 92% were satisfied with their home helper's level of involvement. Two of the 4 home helper respondents were satisfied or very satisfied with the exercise program, and 2 were moderately satisfied. The proportions of older adult participants with no falls or no unplanned hospitalizations were higher in the T4H group (92.3% and 85.7%, respectively) than in the control group (81.8% and 71.4%, respectively), although these intergroup differences were not statistically significant. The T4H and control groups did not differ significantly with regard to the TUG time (median [IQR]: 27.6 seconds [17.9-58.6] vs 30.7 seconds [19.7-57.2], respectively) or the Barthel Index (median [IQR]: 90 [75-95] and 90 [75-95], respectively). CONCLUSIONS: The novel T4H home help model was feasible and was associated with a high level of participant satisfaction. We observed a trend toward fewer falls and hospitalizations and better quality of life in the older adults.

Stepping down backwards as a means of detecting biomechanical differences between healthy older and younger adults.

BACKGROUND AND AIMS: Changes in sensory- motor systems that occur with age result in a decrease in postural equilibrium, which has been linked with an increased risk of falling in the elderly. Stepping down backwards from a step perturbs dynamic postural equilibrium, thus offering an opportunity to analyze the biomechanical parameters underlying the control of balance. The aim of this study was to analyze modifications in motor patterns used by older adult subjects to control equilibrium under the environmental constraint of a backward stepping-down movement. METHODS: Ten healthy young adult and 10 healthy older adult subjects with no previous history of falls stepped down backward from a stable position on a force plate 7 cm high, at a spontaneous velocity. Each subject performed five trials, and the mean of all trials was used for subsequent analyses. An ANOVA was performed, with temporal parameters defining the phases of the stepping-down backward movement, center of mass velocity, vertical ground reaction force, impulse, and slope as dependent variables, and subject group as independent variable. RESULTS: Older adult subjects had a longer total movement duration, a longer phase of anticipatory postural adjustments, and a longer weight-transfer phase than young adult subjects (p<0.05). In contrast, older adults had a shorter relative swing phase than the young adults (p<0.05) and a lower center of mass velocity, impulse and slope (p<0.05) than young adults. CONCLUSIONS: To counterbalance the perturbation of postural equilibrium created by the backward stepping-down movement, older adults decreased the intensity of ground reaction forces and spent correspondingly more time in double-support phases than young adults.

Biomechanical analysis of older adults stepping up: a method of evaluating balance.

The aim of this study was to analyze differences in biomechanical parameters between elderly and control participants when stepping up, to evaluate control of balance. Eleven control and 14 elderly participants performed a step from an initial static posture onto a 7-cm-high force plate. For the spontaneous-velocity condition, elderly participants performed a slower progression velocity than control participants. Elderly participants spent proportionally more time in stance phase, with a corresponding decrease in swing phase, than the control participants, irrespective of movement velocity. In contrast, at spontaneous velocity the parameters related to ground-reaction force (GRF) showed that anteroposterior and mediolateral forces at toe-off of the support limb and the slope of vertical force during weight transfer were significantly smaller for the elderly than for control participants. These GRF parameters depended on the stepping-up velocity. The elderly develop a spatiotemporal strategy and reduced movement velocity to control support balance.

Evaluation of the risk of falling in institution-dwelling elderly: clinical tests versus biomechanical analysis of stepping-up.

Falls in the elderly constitute a major socio-economic problem for modern healthcare. The aim of the study was to extract biomechanical parameters to indicate balance level and the risk of falling in the elderly. It is a preliminary work as part of the development of a home-test based on force-plate technology. Seven faller and 12 non-faller elderly subjects performed stepped up onto a forceplate. Each subject was tested once per weekday for three weeks. Tinetti, Mini Mental Scale test (MMS) and the Geriatric Depression Scale (GDS) scores were measured before the experimentations. Temporal and ground reaction force parameters were measured. The Tinetti test was not correlated with falls in the following six-month period. In contrast, the biomechanical parameters related to the forces measured at foot-contact and to the durations of the phases of the stepping-up were correlated with fall, as well as with MMS and GDS. These results demonstrated that biomechanical parameters could be used as indicators of balance and risk of fall.

Fractal time series analysis of postural stability in elderly and control subjects.

BACKGROUND: The study of balance using stabilogram analysis is of particular interest in the study of falls. Although simple statistical parameters derived from the stabilogram have been shown to predict risk of falls, such measures offer little insight into the underlying control mechanisms responsible for degradation in balance. In contrast, fractal and non-linear time-series analysis of stabilograms, such as estimations of the Hurst exponent (H), may provide information related to the underlying motor control strategies governing postural stability. In order to be adapted for a home-based follow-up of balance, such methods need to be robust, regardless of the experimental protocol, while producing time-series that are as short as possible. The present study compares two methods of calculating H: Detrended Fluctuation Analysis (DFA) and Stabilogram Diffusion Analysis (SDA) for elderly and control subjects, as well as evaluating the effect of recording duration. METHODS: Centre of pressure signals were obtained from 90 young adult subjects and 10 elderly subjects. Data were sampled at 100 Hz for 30 s, including stepping onto and off the force plate. Estimations of H were made using sliding windows of 10, 5, and 2.5 s durations, with windows slid forward in 1-s increments. Multivariate analysis of variance was used to test for the effect of time, age and estimation method on the Hurst exponent, while the intra-class correlation coefficient (ICC) was used as a measure of reliability. RESULTS: Both SDA and DFA methods were able to identify differences in postural stability between control and elderly subjects for time series as short as 5 s, with ICC values as high as 0.75 for DFA. CONCLUSION: Both methods would be well-suited to non-invasive longitudinal assessment of balance. In addition, reliable estimations of H were obtained from time series as short as 5 s.

Identification of a degradation in postural equilibrium invoked by different vibration frequencies on the tibialis anterior tendon.

The aim of the study was to compare the effect of different vibration frequencies applied to the tibialis anterior tendon on the control of postural equilibrium. Sixty-three parameters were analyzed, with 44 of them showing an effect of vibration. The greatest differences were observed for those parameters related to movement in the anteroposterior direction. Such a result was due to the direction of postural sway induced by the vibration. There were no differences between the control condition and vibration at 50 Hz. However, both 70 and 90 Hz vibrations produced similar results. The method of postural perturbation presented here might be useful to test the sensitivity of parameters extracted from COP signals in terms of their capability to detect small changes in postural equilibrium.